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Facility Factors Influencing Utilization of Active Management of Third Stage Of Labour among Skilled Birth Attendants in Kiambu County, Kenya
(Supplement article, 2016-11-26) Felarmine, Muiruri; Joachim, Osur; Agina, Okello
Introduction: Post-Partum Hemorrhage (PPH) accounts for 34% of maternal deaths in Kenya. Active management of third stage of labour (AMTSL) is a World Health Organization and Ministry of Health of Kenya approved protocol for reducing maternal mortality and morbidity arising from postpartum hemorrhage. Kiambu County in Kenya records an average of six maternal deaths per month, out of which, two are due to PPH. This paper analyses how facility factors influence utilization of this protocol in Kiambu County. Methods: this was a cross sectional study among 431 skilled birth attendants in 52 health facilities. Two hundred and three birth attendants were selected using multistage sampling. Data was collected using questionnaires and observation checklists and analyzed using STATA version 11. Chi square, Fisher’s exact and Logistic regressions tests were used. Results: AMTSL was utilized by 31.5% of the birth attendants. Controlled cord traction (96.5%) was the most utilized. Uterine message after every 15 minutes was the least utilized component. Utilization was more in government facilities (37.4%) (Logistic regression p=0.006) and in level four health facilities (49.5%) (p<0.001). Utilization was higher (34.7%) among birth attendants who experienced less frequent stock outs (p=0.027) and in facilities with more than two staff authorized to order supplies (34.9%) (p=0.020). Utilization was higher in facilities with a fridge (44.5%) (p=0.001) and in facilities with standards documents in the labour ward (68.0%) (p=0.001). Conclusion: health facility factors significantly influence utilization of AMTSL and therefore the county government should put in place strategies to enhance the factors that influence utilization of AMTSL positively
Home Deliveries in Rural and Urban Districts in Kenya
(paper publication, 2017-03) Kabue, Priscilla
Home deliveries is common in developing countries Kenya included where mothers are assisted by Traditional Birth Attendant during delivery. Most birth which occur at home can result in complications which cannot be handled in the absence of qualified health personel and a health facility. To reduce maternal mortality its important that mothers deliver in a hospital with qualified health personnel. Objective: The study aimed at establishing the factors that contribute to home deliveries in both rural and urban Districts in Kenya. Methodology: A cross sectional study design was preferred. A sample of four hundred postnatal mothers in Rural and Urban hospital attending maternal child health clinics were selected for the study. Eligibility was mothers who had delivered at home within one year prior to the study. Focus group discussion guides were used to collect data. Data was analyzed by correspondence and thematic analysis and presented in figures and summary narratives. Results: Most mothers in rural area delivered at home compared to urban 119 Mothers delivered at home in rural while only 47 did so in rural area. This is associated with lack of money and transport. Home deliveries are preferred because they are cheap, no cost of travelling, TBA have a positive attitude and use polite language, there is one to one care so chances of self-delivery do not arise and mothers are in familiar environment. Conclusion: Home deliveries are still common in Kenya despite availability of health services. Recommendation: Health worker should improve during delivery on the care they give to the mother irrespective of their socio-economic status
Assessing Barriers to Implementation of Nursing Process among Nurses Working at a Tertiary Hospital in Kenya
(Researchjournali’s Journal of Public Health, 2018-01) Mbithi, Dennis N.; Blasio, Omuga; Ayieko, Antony; Githui, Simon N.; Wambugu, Paul
Background: Nursing process (NP) is a global concept, which forms the foundation of nursing as a profession, it is a scientific method for delivering holistic and quality nursing care and its effective implementation is critical for improved quality of nursing care. However, its implementation in most hospitals especially in low and middle-income countries reportedly remains a challenge despite efforts being made. Objective: To assess barriers to implementation of nursing process among nurses. Methods: A descriptive cross-sectional study was carried out where 134 nurses were recruited in the study. Data was collected through self-administered questionnaires. Results: One-third (33.1%) of nurses reported that they were actively implementing the nursing process but only 8.2 %( n=11) nurses correctly listed all the steps of the nursing process. Nursing process implementation was significantly associated with nurse’s demographics (age p <0.001, experience p = 0.001), training (p = 0.013), institutional factors (p = 0.048). Social (p>0.05) and cultural (p = 0.993) factors were not significantly associated with nursing process implementation. Conclusion: The Nursing Process implementation among nurses is significantly influenced by their demographic characteristics which include age and experience, training on nursing process and institutional factor like availability of relevant resources for NP implementation.
Evaluation of Patient Satisfaction with Nursing Care at Two Public Hospitals in Kenya: An Interventional Study
(Medwin Publishers, 2018-05-14) Githemo, Grace K; Karani, AK; Ogutu, M; Gachoka, H
Introduction: Patients’ satisfaction with nursing care has been reported as the most important predictor of the overall satisfaction with hospital care. However, measuring patient satisfaction within health care settings still needs more emphasis. This is mainly because, as in other organizations and sectors, surveys have tended to focus on managers’ and clinician’s agendas and not on questions meaningful to patients which can be translated into actions. Study Design and Objectives: This quasi experimental study aimed at evaluating the level of patient satisfaction with quality of nursing in two public hospitals in Kenya after the nurses were trained on the use of the nursing process and nursing theory in patient care with an emphasis on patient participation in care. Structured self-administered questionnaires and a Likert like scale were used to collect data which analyzed by use of SPSS. Descriptive statistics were used in data presentation. Chisquare test of significance was used to determine the difference between pre-test and posttest while logistic regression analysis was used to predict the determinants of satisfaction at post-test. Findings: The findings showed a significant difference (p<0.05) between pre-test and post-test on the level of patient satisfaction with the variables evaluated. Logistic regression findings showed that females were more likely to be satisfied with the introduction they received in the ward (OR1.82,95%CI1.074-3.3098) compared to their male counter parts. Also patients with primary level of education were less likely to be satisfied with the information received on introduction (OR 0.568,95%CI0.334–0.967). Conclusion: The study concluded that Majority of the patients in both study groups were satisfied with the information received on admission, satisfied with orientation and with the overall quality of nursing care they received. Also the level of education influenced patients’ perception of individualized quality care. Therefore equipping patients with education can help them understand their health care needs and also appreciate quality when it’s provided.
Evaluation of Cardiopulmonary Resuscitation Knowledge and Its Impact on Practice among Clinicians at a County Referral Hospital in Kenya
(IISTE, 2019) Ndung’u, Paul; Kimani, Samuel; Kirui, Angeline; Mukonene, Jerusha
Background: Cardiopulmonary resuscitation (CPR) is a life-saving emergency procedure that ensures oxygen and blood supply in a victim who have had heart and/or breathing stoppage thereby maintaining the viability of vital organs until professional help arrives. All the health care workers should have adequate knowledge and skills to perform the procedure with ease in case of cardiac arrest. Sudden cardiac death in the western countries ranges from 300,000 to 400, 000 annually. This represents 0.36 to 1.28 per 1000 population in Europe and the United States. American Heart Association approximates that 100000 to 200000 adult lives could be saved annually if CPR is initiated early enough. The outcome of a patient with a cardiac event is determined by the knowledge and skills of the resuscitator and the promptness in which the procedure is instituted and the nature of the patient condition among others. Objective: To evaluate CPR knowledge and its impact on practice amongst clinicians working at Coast General Hospital, Mombasa Kenya. Methods: A descriptive cross sectional study was carried at the hospital in 2015 where a questionnaire was administered to 91 nurses, 27 clinical officers and 24 doctors. Results: The study comprised of 142 clinicians; 63.8% (n=90) nursing officers, 19.1% (n=27) clinical officers and 17.1% (n=24) medical officers. Their levels of training were; 57.4% (n=81) diploma, 25.5% (n=36) bachelors degree, 12.8% (n=18) higher diploma, 2.8% (n=4) certificate, and 1.4% (n=2) masters degree. The level of training was significant (P =0.04) on the way they rated their CPR practices. It’s only a quarter of the clinicians who trained CPR at their respective colleges. A majority 68.8% (n=97) had trained on CPR and the training was significant (P=0.000) on the way they rated their CPR practices. Three quarters 75.9% (n=104) were scored below average on specific aspects on CPR knowledge. This was significant (P =0.001) on their rating of CPR practices. A third 33.3% (n= 47) of the clinicians had taken more than three years since their last training. This significantly (P =0.000) affected the way they rated their CPR practices. Conclusion: The CPR practices at Coast General Hospital are significantly affected by the clinicians’ knowledge. The hospital administration needs to plan for frequent refresher trainings for all the staff. Professional bodies need to encompass CPR CPD points as a requirement to renewing practicing licences.
Nurse’s Knowledge Aspects of Enhancing Haemoglobin Level and Safety through Delayed Cord Clamping Time in a Semi-urban Hospital in South Rift Region, Kenya
(Kabarak Journal of Research & Innovation, 2019) Bor, Wesley; Mbithe, Dorcus; Ogada, Irene; Too, Wesley
The clamping of the umbilical cord can be done at different times after delivery, although delaying the clamping of the cord for ≥ 1 minute after birth improves the haemoglobin levels for newborn and variation may lead to safety issues and influence of the haemoglobin status of the infants. There is limited literature on the knowledge of health care providers on the optimal time to clamp the umblical cord after delivery. The objective was to assess the nurse’s knowledge aspect on enhancing haemoglobin levels through delayed cord clamping in a Semi Urban Hospital in South Rift Region, Kenya. The Participants nurses in the study were enrolled through simple random sampling in maternity and delivery rooms and the aspect of knowledge was assessed using Pre-test questionnaire. Half of the nurses (50%) had knowledge that delayed clamping is recommended. However, 69% had knowledge that delayed cord clamping should be performed for those infants requiring essential care under maximum safety conditions while 94% reported that delayed cord clamping is beneficial to the infant and does not interfere assessment of the baby and administration of uterotonic drugs. A bout 31% had incorrect knowledge that delayed umblical cord clamping increases the infant’s risk of acquiring HIV. Half of the nurses (50%) of nurses had knowledge that the World Health Organization (WHO) 2014 guidelines recommended delayed cord clamping for all infants without medical complications including infants of women who are HIV positive. The nurse’s knowledge on the optimal time to clamp the umblical cord after delivery was not uniform. Majority of the nurses had knowledge that delayed cord clamping increases the risk of mother to child HIV transmission and aspect of knowledge affected the safety level of infant haemoglobin levels. Relevant stakeholders should consider developing national guideline and standard operational procedures on Umblical Cord Clamping after delivery.
Utilization of Immunization Services among Children Aged Under Five in Kirinyaga County, Kenya
(International Journal of Community Medicine and Public Health, 2019) Njeru, Margaret W.; Kabue, Priscilla N.; Gachau, Albert G.
Background: Immunization is the key strategy to curb communicable diseases which are the number one killer of children under five years of age. Immunization prevents mortalities of approximating three million children under five years annually. This study aimed to assess utilization of immunization services among children aged under five in Kirinyaga County, Kenya. Methods: This was a descriptive cross-sectional study conducted among 388 participants in the five sub-counties of Kirinyaga County through systematic random sampling. Data was collected using a structured interview and review of recorded data from the Children immunization record card. Data was analyzed using SPSS and chi-square tests used to measure the association between independent and dependent variables. Statistical significance was set at p≤0.05. Results: Immunization at birth and at 6 weeks was highly utilized at 91%. However, there was a decline during the subsequent visits. Age, gender, profession and level of income were significant factors that affected timely immunization. Health service barriers to utilization included long ques and waiting time, stock out of vaccine and rescheduling of vaccination and clinic return dates. Other identified factors were myths and misconception, side effects, parity and lack of information. Conclusions: The results showed that utilization of immunization services was not in compliance with the expanded programme on immunization schedule. There is therefore need for health education programs to be carried out to improve utilization of immunization services and a door to door campaign to trace and immunize defaulters.
Prevalence and Risk Factors for Perineal Trauma among Women at a Teaching and Referral Hospital in Kenya
(IISTE, 2019) Kituku, Jacqueline; Getanda, Amos; Mwangi, Ann
Perineal trauma is classified according to the degree of structures involved or according to the depth of the injury. Mild perineal trauma is very common following vaginal delivery. Risk factors for perineal trauma include primiparity, precipitate labour, instrumental deliveries, pushing techniques and birth positions. Perineal trauma is associated with significant short-term and long-term complications. The objective of the study was to determine the prevalence and risk factors for perineal trauma among women at teaching and referral hospital in western Kenya. A cross-sectional study was carried out at the teaching hospital between April and May 2015. Two hundred and nine women who had come to deliver at the facility were consented to participate in the study. A structured checklist was used to obtain data from the women and make observations as skilled care givers attended to deliveries. All analyses were performed at 95% level of confidence. Two hundred and nine (209) deliveries were observed. Majority of the women, 76 (36.40%), were in the 20-24 age group. Ninety seven (46.10%) of them were para 0. Eighty one (38.8%) of the women sustained various types of perineal trauma. Supine position during delivery was the most preferred position, in 201 (96.2%), of the women. Age of the mother, parity, infant birth weight, and history of previous trauma, were statistically significant, associated with trauma in the univariate analysis (p=0.013; p=0.000; p= 0.010; p= 0.033) respectively. Adjusting for other factors, the odds of sustaining perineal trauma increased with increased birth weight (OR 2.878; p= 0.005) and decreased with increasing parity (OR 0.037; p=0.000). The prevalence of perineal tears as revealed by the study was 38.8%. This study recommended evidence based practice during labour and delivery in order to improve pelvic floor outcomes as well as reduce operative deliveries and long term morbidities.
Level of Knowledge among Adolescent Girls on Modern Contraception at Tsangano Turnoff Community, Ntcheu District, Malawi
(IPRJB, 2019) Damson, Ellen Chifundo; Keraka, M; Kabue, P
Purpose: The purpose of this study was to establish level of knowledge among adolescent girls on modern contraception at Tsangano Turnoff community, Ntcheu District, Malawi Methods: The study used a cross sectional study employing both simple random sampling technique for quantitative data and purposive random sampling technique for qualitative. The research instruments were self-administered questionnaires and Focused Group Discussions (FGD). Quantitative data was analyzed using Statistical Package for Social Sciences version 22.0. Analysis proceeded in two steps. First, univariate descriptive statistics were used to describe sample characteristics and estimate contraceptive prevalence among the adolescents. Contingency table methods were used to test associations between independent (categorical) variable and utilization of contraception and the qualitative data from the FGDs was transcribed and analyzed by thematic content analysis techniques. Results: This study found that a lot of adolescent girls had general knowledge regarding modern contraception as majority reported to have knowledge about modern contraception (73.9%). This study has shown that utilization increases with the increase in the level of knowledge as it has shown that out of the all the 54 respondents who reported to be utilizing modern contraception all of them had moderate to high knowledge regarding contraception. The results shows that utilization is highly significant statistically to knowledge as those respondents who had adequate knowledge they are four times more likely to utilize modern contraception than those who has little or no knowledge. Unique Contribution to Theory, Practice and Policy: The study recommended that Knowledge on modern contraception is very important in the utilization of the contraceptive hence since education is one way of empowering the girl child to be a reliable citizen in future therefore the high existing knowledge reported in this study should be encouraged and be related to utilization of modern contraception and other sexual and reproductive health services.
Sexting and Risky Sexual Behaviour among Students in Machakos University, Machakos County. Kenya
(IPRJB, 2020) Mukonyo, Musyimi Elizabeth; Mugo, Judy; Kabue, Priscilla
Purpose: The purpose of this study was to investigate sexting practice among students and identify the risky sexual behaviors associated with sexting among students in Machakos University, Machakos County, Kenya. Methodology: The study adopted a descriptive cross-sectional study design. The target sample was 347 students aged 18-24 years in Machakos university. Convenience sampling was used for quantitative data and purposive sampling for qualitative data as well as the study area. Interviewer-administered questionnaires were utilized and in-depth interview used for the qualitative data collection. The IBM SPSS version 26.0 was used for data analysis. Thematic analysis was used to analyze the qualitative data and triangulated with quantitative findings. Results was presented in tables, graphs and pie charts. Chi square test was done to identify variables associated with sexting and odds ratio to measure the association between sexting and risky sexual behavior. Findings: Sexting (sending of sexually suggestive image/photo) was found to be prevalent among the student at 57% and 48% being two-way sexters. Male respondents engaged more into sexting as compared to female respondents at 67%and 33% respectively.23.0% sexted to keep or get a boy/girlfriend and 14% due to pleasure from their peers. Gender, Age, Level of study and relationship status were all significantly associated with sexting (P=0.000, P=0.027, P=0.002 and P=0.022 respectively). Risky sexual behaviors among students included early sexual intercourse 74%, but 54% had not used protection. Sexting and risky sexual behavior were found to be associated because most of the respondents who engaged in sexting were eight times more like to engage in early sexual intercourse, and the perception of sexters was that if one was sexting they were six times likely to have sex with the person they sexted, and so the null hypothesis that there is no relationship between sexting and risky sexual behavior was rejected and the alternative hypothesis adopted. Unique contribution to theory, practice and policy: Adoption of Multi sectoral to develop policies, and design youth programs with a wide range of issues relating to sex and sexuality and how to safely navigate the internet and form healthy relationships both on and offline, which include issues such as sexting with young people from a young age.
Psychological Stressors among Hemodialysis Patients in Selected County Dialysis Centre’s in Kenya
(Nursing & Primary Care, 2021) Mugi, Elizabeth; Githemo, Grace; Wala, Jonathan
disease, the modality is associated with multiple psychological stressors that confronts the hemodialysing patients and subject them to mental disturbances and poor quality of life. Study aim: The study aimed at describing the psychological stressors faced by the hemodialysis patients in the new county dialysis centers in Kenya and to correlate the psychological stressors to the patients’ demographic characteristics. Methodology: This was a descriptive correlation study among hemodialysis patients in four selected county dialysis centers in Kenya. Sample size was determined through a census method. Data was collected by means of a semi-structured questionnaire and analyzed using a Statistical Package for Social Sciences (SPSS) version 25.0.Findings were presented using graphs and frequency tables while Chi-square was used to test for the association between study variables. Results: Despite opening new county dialysis centers, majority of the respondents identified inadequate number of hemodialysis machines as the major psychological stressor (M=2.9, SD ± 0.8) uncertainty in life (M=2.74, SD ± 0.6) and lack of hemodialysis commodities (M=2.69, SD=0.7) as the leading psychological challenges faced by the patients who are dialyzing in the newly opened county dialysis centres in Kenya. There was a statistically significant association (p=0.016) between waiting time for hemodialysis sessions and gender and also a significant association (p=0.04) between marital status and dependency on others to bring them for dialysis session. Conclusion: Despite the Government initiative to increase the availability and accessibility of the hemodialysis services to hemodialysis patients, inadequate hemodialysis machines, lack of hemodialysis commodities and difficulties in raising the cost of treatment still remains the major psychological stressors among hemodialysis patients. Therefore, opening of new dialysis centers should be accompanied with adequate resource allocation to guarantee positive patient outcomes.
Quality Of Life for Kidney Donors after Donation at A national teaching and Referral Hospital in Kenya
(Numid Publishers, 2021) Nyahera, Diviner K; Githemo, Grace; Onsongo, Lister N
Introduction: Kidney transplantation is the best renal replacement therapy for patients withend stage kidney disease. Living kidney donor transplant has better graft and recipient outcome. Information regarding quality of life of kidney donors has a positive influence onapotential donor’s attitude towards kidney donation. The aim of the study was to examinekidney donors’ quality of life in Kenya. Methods: This was a cross-sectional descriptive study design that aimed at examiningthequality of life of kidney donors’ after donation at a national teaching and referral hospital inKenya. A total of 99 donors participated in the study. Descriptive and inferential statistical tests were used to analyze data. Predictors of quality of life were determined using multipleregression models. Findings: Majority of the respondents had high quality of life. There was a strongsignificant relationship between donor’s Body Mass Index and Health Functioningcomponent of QoL r (0.835), p<0.05 with a moderate relationship in Psychological factors r (0.492), p > 05. Also there was a statistically significant association between, current monthly income, x 2(1, � = 99) =24.793, (p <0.05), marital status x 2( 1, � −99) =10.261(p<0.05) and employment status x 2( 1, � = 99) =11.474 (p <0.05) and quality of lifeof kidney donors. Multiple regression analysis revealed that Health functioning quality of lifecomponent explained 27.5% of the total variance of quality of life while psychological factors explained 12.5%. Conclusions: The overall quality of life of kidney donors was high. Kidney donor’semployment status had a significant predictive association with their quality of life.
Professional Quality of Life among Nurses Caring for Cancer Patients
(Stratford Peer Reviewed Journals and Book Publishing, 2021) Gikonyo, Catherine W.; Onsongo, Lister; Ogutu, James O.
This study aimed at assessing the level and determinants of professional quality of life (compassion satisfaction, compassion fatigue, and burnout) for cancer care nurses. A descriptive correlation was conducted among 90 cancer care nurses using ProQoL Version-V and Brief COPE inventory self-administered questionnaires. Stratified sampling was used to select the study participants from different units. There was a high score for compassion satisfaction 42±4.76, low to average burnout 33±4.7, and compassion fatigue 27±8.7 scores. There was a statistically significant difference in the levels based on some demographic factors and personal factors. A negative relationship between compassion satisfaction with exposure to chemotherapeutic, workload, and insufficient preparation with Staff patient ratio was noted to be the major predicting factors for all subscales of ProQoL. Organizational and personal intervention measures such as self-care, a mentorship program for upcoming new oncology staff, and training cancer caregivers. A study with a large sample is highly recommended.
Nurses’ Management of Patients with Pressure Ulcers in Selected Health Facilities in Murang’a County, Kenya.
(eajhs, 2021) Njoroge, Jane Muthoni; Kabue, Priscillah Njeri; Ochieng, James
Pressure ulcers are a common health problem in hospitalized patients, especially among patients with chronic illnesses and those with reduced mobility. The prevalence of pressure ulcers varies with health care settings and is highest in critically ill patients ranging between 15-20%. They affect the quality of life of patients and caregivers and have been associated with heavy financial burdens, extended hospital stays, higher morbidity and mortality. Inadequate prevention measures and lack of active management of pressure ulcers in early stages especially in high-risk patients result in recurrence and complicated pressure ulcers. In view of this, a descriptive cross-sectional study was conducted in Murang’a County, Kenya in selected health facilities with the objective of determining the management of patients with pressure ulcers. The study population was composed of one hundred and twenty-four (124) nurses working in medical and surgical wards in selected health facilities. Semi-structured questionnaires, observational checklists and focused group discussions were used to collect data. The qualitative data from the focus group discussions and observational checklist were transcribed and a summary written. The relationship between nurse’s knowledge, nurse-oriented factors and institutional factors affecting management of pressure ulcers among nurses were examined using Pearson correlation analysis and multiple regression analysis. The median age of the respondents was 37 years with at least 112 (90.3%) having diploma level of education, and 63 (50.9%) were from the medical department. The majority of the nurses (93.6%) agreed pressure ulcers can be avoided, while 58.1% preferred pressure ulcer risk assessment tools compared to 27.5% who preferred clinical judgment in the management of pressure ulcers. The majority of nurses (87.5%) who had adequate knowledge on the management of pressure ulcers mentioned immobility and bedridden patients, stroke, spinal injury, dry skin, stool and urine incontinence asmajor contributors to pressure ulcers. Regarding pressure ulcer risk assessment, 62.9% of nurses assessed patients for pressure ulcers though they relied on clinical judgement as 93.9% indicated there was no risk assessment scale in the wards and 5.1% were not sure. On institutional factors 61.3% of the nurses indicated that health facilities were lacking pressure ulcer reducing devices and those that had pillows and a few ripple mattresses. Regarding guidelines in the management of pressure ulcers, 75.8% of nurses indicated they were not available in the hospital. The study found an association between age and knowledge increasing the odds of effective management age (AOR = 6.83, p = 0.001); experience (AOR = 4.08, p = 0.01), and education (AOR = 22.9, p = 0.000). The nurse-oriented factors increasing the odds of effective management of pressure ulcers include nurse’s positive attitude on prevention of pressure ulcers (AOR = 2.3, p = 0.040) and nurse use of pressure ulcer risk assessment tool (AOR = 4.3, p = 0.010). On institutional factors, nurses trained on management of pressure ulcers were 4.47 times likely to effectively manage patients with pressure ulcers. Nurses who lack in-service training about pressure ulcers were less likely to effectively manage patients with pressure ulcers (AOR = 0.11, p = 0.000). The study concludes that the nurses had adequate knowledge in management of pressure ulcers, the nurses-oriented factors and institutional factors also influence the management of pressure ulcers
Role of Traditional Birth Attendants in Providing Pre and Postnatal Care to Mothers in Refugee Camps: A Case of Ifo Camp Dadaab Kenya
(med crave, 2021) Mwoma, Teresa; Kituku, Jacqueline; Gitome, Josephine; Kahumbi, Newton; Ndegwa, Priscila; Maina, Muthoni; Bagelman, Jen
Access to skilled birth attendance is critical in improving maternal and newborn health. However, in low resource settings, rural and refugee camps, professionally trained staff are often in short supply hence women tend to rely on traditional birth attendants (TBAs) for delivery. Despite knowledge that a health care facility delivery is safer, many women from low resource environments continue to seek for the care of TBAs. In order to understand the care provided to refugee women during pregnancy and after birth, in a refugee camp, a study was conducted in Ifo Dadaab refugee camp in Kenya. The aim of this article therefore, is to document findings on participants’ perspectives on pre and post-natal care provided to women in refugee camps during pregnancy and after birth. This was a qualitative study conducted in Ifo refugee camp in Dadaab Kenya. Nine participants were purposively selected for the study to give their perspectives on the role of TBAs in providing caregiving support to refugee women during pregnancy and after birth. The participants included two married men, three traditional birth attendants, two Somali pregnant women and two refugee safe mothers. Data was collected through focus group discussions and interviews. The data was beefed up with feedback from dissemination of preliminary findings to stakeholders’ validation conference held at Kenyatta University. Findings revealed that TBAs play a critical role in supporting women during pregnancy and after birth. However, they are not able to attend to complications associated to delivery. Among the caring support cited include, guiding and counselling pregnant women, educating them on the importance of attending antenatal clinics, massaging women during labour, praying for the baby after birth, and escorting women to the health facilities to take their babies for immunization. It was also apparent that TBAs advise pregnant women on the herbs they should have in stock while pregnant. In addition, they advise women to breast feed their babies immediately after birth. While TBAs are able to assist un complicated births at home, it was apparent that it becomes challenging for them to provide support for women with complication during the birth process. In view of this, it will be more helpful for TBAs to be encouraged to guide and advise pregnant women to deliver in the health care facility, where they can escort them to get professional attention during birth.
Factors Influencing Quality of Life among Cancer Survivors in Kenya
(AJOL, 2022) Kung’u, Mary; Onsongo, Lister; Ogutu, James O
Background: The number of cancer survivors is growing continuously due to advances in treatment of cancer patients. In developed countries, numerous studies on quality of life (QoL) of cancer survivors have been conducted. Little is known regarding the QoL of cancer survivors in Kenya. Therefore, the aim of this study was to explore the factors that contribute to QoL of cancer survivors in Kenya. Methods: A descriptive cross-sectional design was used for the study. Participants were 108 adult cancer survivors. Self and interviewer administered QoL Patient/Cancer Survivor Questionnaire was used Results: Findings indicate a statistically significant relationship between QoL and age (rs =-.055 p<.05), marital status (rs=.490 p<.01), income (rs =.228 p<.05), stage of cancer diagnosis (rs =-.269. p<.01), year of cancer diagnosis (rs =-.295 p<.01), religious affiliation (rs =-.279, p<.01) and the religion one belonged to (rs =-.198 p<.05). Regression analysis showed that age, stage of cancer diagnosis, time off treatment, educational level, and religious affiliation are significant predictors of QoL in cancer survivors. Conclusions: The findings highlight the importance of key factors associated to QoL in cancer survivors in Kenya. Interventions aimed at early cancer detection, treatment, and spiritual support among cancer survivors will improve QoL
Nursing Handover: Experiences and Perspectives in the Critical Care Unit at Murang’a County Referral Hospital
(Stratford Peer Reviewed Journals and Book Publishing, 2022-11) Murigi, Mwangi; Mbuthia, Nickcy; Meng’anyi, Lucy
Continuity in delivery of nursing care to patient in the critical care unit is of utmost importance. Although nurses have a variety of guidelines and formats to conduct the handover, gaps have been detected regarding the contents of the handover and its effects on the continuity of care in the critical care unit. The focus of the study was to explore the experiences and perspectives of nurses with nursing handover in the critical care unit. The study adopted a phenomenological qualitative design. A sample of 9 critical care nurses participated in this study. The study found critical care nurses believed they were individually equipped with adequate knowledge to carry out effective departmental and interdepartmental nursing handover. The existence of handover policies in the critical care unit was considered a major enabler of the handover. The participants also believed that strained human resource, lack of standardized handover tools and deviation from the set handover rules negatively impacted the handover process. Furthermore, they reported perceived insufficiency in the management’s role in handover evaluation and feedback. Moreover, all participants advocated for improvement of the current handover practices for improved quality of patient care as well as sense of self-accomplishment among the nurses. There are pertinent implications in the findings of this research for critical care nurses, nurses in other departments and policy makers. The resultant implication for each group of stakeholders promotes the adoption and formulation of effective handover practices and consequently enhanced quality of patient care through transfer of adequate patient information and sense of self-accomplishment among nurses.
A Training Program for Obstetrics Point-of-Care Ultrasound to 514 Rural Healthcare Providers in Kenya
(BMC Medical Education, 2023) Wachira, James; Matheka, Duncan Mwangangi; Masheti, Sheila Ayesa; Githemo, Grace Kirigo; Shah, Sachita; Haldeman, Matthew S.; Ramos, Mena; Bergman, Kevin
Background Ultrasound is a crucial and efective diagnostic tool in medicine. Recent advancements in technology have led to increased use of point-of-care ultrasound (POCUS). Access to ultrasound equipment and training programs in low-and middle-income countries (LMICs) is limited. Despite the World Health Organization (WHO) recommendations for universal antenatal ultrasounds, POCUS for reproductive health applications has not been widely used in LMICs. We describe here the feasibility of implementation of a training of obstetrics point-of-care ultrasound (OB POCUS) for high-risk conditions in rural public healthcare facilities in Kenya with partnership from Butterfy Network, Global Ultrasound Institute, and Kenyatta University. Methods As part of the initiation of a large-scale implementation study of OB POCUS, clinician trainees were recruited from rural Kenyan hospitals for participation in a series of fve-day POCUS workshops held between September and December 2022. Trainers provided brief didactic lessons followed by hands-on training with live models and at regional clinical sites for 5 OB POCUS applications. Instructor-observed assessment of students’ scanning and image interpretation occurred over the training period. Assessment of knowledge and confdence was performed via an online pre-test and post-test as well as Objective Structured Clinical Examination (OSCE) was administered at course completion. Results Five hundred and fourteen mid-level Health Care Providers (HCPs) in Kenya were trained over a threemonth period through in-person didactic sessions, bedside instruction, and clinical practice over a 5-day period with a trainer: trainee ratio of approximately 1:5. Out of the 514 trained HCPs, 468 were from 8 rural counties with poor maternal and neonatal outcomes, while the remaining 46 were from nearby facilities. OB POCUS topics covered included: malpresentation, multiple gestation, fetal cardiac activity, abnormalities of the placenta and amniotic fuid volume. There was marked improvement in the post training test scores compared to the pretest scores. Conclusion Our implementation description serves as a guide for successful rapid dissemination of OB POCUS training for mid-level providers. Our experience demonstrates the feasibility of a short intensive POCUS training to rapidly establish specifc POCUS skills in eforts to rapidly scale POCUS access and services. There is a widespread need for expanding access to ultrasound in pregnancy through accessible OB POCUS training programs. An implementation study is currently underway to assess the patient and systems-level impact of the training.
Psychological Effects Experienced by Mothers who’s Neonates Are Admitted in ICU at a National Hospital with Gastroschisis: A Phenomenology Study
(Full Length Research, 2023) Thaiya, Rosemary Muthoni; Gachuiri, Grace; Bett, Sarah
Background: Gastroschisis is a rare congenital condition that occurs while a fetus is in the early stages of development that results in the abdominal wall having a protrusion of abdominal contents – small and large intestines and the stomach. Delivery of a neonate with chronic illnesses like gastroschisis greatly affects mothers and caregivers because neonates who do not receive surgical care immediately after delivery end up losing their lives, while those who do survive require extensive medical care that requires additional hospitalization and comprehensive care which many parents are unsure how to provide or able to afford. Broad Objective: To explore the psychological effect exhibited by mothers whose neonates are admitted in Neonatal Intensive Care Unit (NICU) in the Kenyatta National Hospital with gastroschisis. Methodology: A qualitative study guided by descriptive phenomenology was conducted. In-depth-interviews with twenty-five (25) mothers purposively sampled, Interviews were audiotaped, the data later transcribed inductively analyzed into themes and sub themes. Findings: Two themes were developed first, Stages of grieving. Some mothers experience shock when they saw the condition of the neonates with denial feeling that what they were seeing was not real. They felt angry with God and bargained on the same hoping that things would change. The mothers went into depression and finally accepted their situation as they came to terms with reality. The second theme was mental health issues: in this case, admission of the neonates in NICU caused mental negative psychological effects to the caregivers. They suffered separation anxiety from other family members. There was delegation of roles at home as some had other children. There was fear of stigma and lack of support from the families. In NICU, caregivers received peer support from themselves as they shared different experiences. Recommendations: Concerted efforts by the stakeholders in the Healthcare sector are necessary in order to alleviate the negative psychological effects felt by mothers of children born with gastroschisis.
Women's Experience of Unexpected Caesarean Section Birth in Kitui County, Kenya
(ahs, 2023) Kimanthi, Zipporah K; Onsongo, Lister N
Background: In sub-Saharan Africa, 72% of all Caesarean section (CS) births are unplanned compared to 27% of unplanned CS births done in developed countries. Various researches have been conducted on lived experiences following unexpected CS birth but none in Kitui County, Kenya. Objective: This study described the lived experience of undergoing an unexpected CS and the role of cultural beliefs on childbirth among Kitui/Kamba women in Kenya. Methods: A descriptive phenomenology design was used in this study. In-depth interviews of women who experienced unplanned Caesarean birth in Kitui County, Kenya, were conducted. Colaizzi’s method guided the analysis. Interviews were approximately 30 minutes long and audiotaped. Results: A total of 12 mothers participated in the study. Fives themes and 11 sub-themes emerged from this study: fear (fear of disability and surgical complications), pain (physical and psychological pain), less of a woman (lowered self-esteem, powerless and worry), sullied (dispirited and will loss), and fallacy (misconception and effects of fallacy). Conclusion: Disruption, dissatisfaction with the birth process, and unmet expectations were negative experiences. Healthcare workers should be sensitive when informing mothers of unplanned CS. More research to look for coping strategies to reduce negative birthing experiences.

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